AAP releases guideline on outpatient opioid prescribing for acute pediatric pain

October 3, 2024

Summary of key action statements from AAP’s new guideline:

Strong recommendations

• Acute pain should be managed using a multimodal approach that includes appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications.
• Opioid monotherapy should not be prescribed for children and adolescents with acute pain.
• Don’t prescribe codeine or tramadol in the following situations: acute pain in children and adolescents <12 years of age; acute pain in adolescents 12 to 18 years of age who have obesity, obstructive sleep apnea, or severe lung disease; postsurgical pain after tonsillectomy or adenoidectomy in children and adolescents <18 years of age; acute pain in people of any age who are breastfeeding.
• For acute pain in children or adolescents who are taking sedating medications (e.g., BZDs), use caution when prescribing opioids.
• When prescribing opioids, educate caregivers about safe disposal of unused medications, help caregivers develop a plan for safe disposal of unused medications, and, if possible, offer safe disposal in the prescriber’s office setting.

Recommendations

• When prescribing opioids for acute pain in children and adolescents, choose immediate-release opioid formulations, start with the lowest age- and weight-appropriate doses, and provide an initial supply of 5 days maximum, unless pain is related to trauma/surgery with an expected duration of pain of >5 days.
• When prescribing opioids, provide naloxone and counsel patients and families on the signs of opioid OD and on how to respond to an OD.

Options

• When prescribing opioids, educate caregivers about safe storage and directly observed administration of medications to children and adolescents.
• For acute, worsened pain in children and adolescents with preexisting chronic pain, prescribe opioids when indicated and collaborate with any other opioid-prescribing clinicians involved in the patient’s care as well as specialists in chronic pain, palliative care, and/or other opioid stewardship programs to determine appropriate treatment plan.

Source:

Hadland SE, et al. (2024, September 30). Pediatrics. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. https://pubmed.ncbi.nlm.nih.gov/39344439/